Breast ptosis is the medical term for the structural shift resulting in the “sagging” or drooping of breast tissue. This common anatomical change is not a disease, but a progressive alteration in the breast’s shape and position over time. It represents a natural descent of the breast mound on the chest wall, affecting women of all body types and ages. The degree of ptosis varies, influenced by genetics and life events.
Defining Breast Ptosis
Ptosis is defined by the relationship between the nipple and areola complex (NAC) and the inframammary fold (IMF). The IMF is the natural crease beneath the breast where it meets the chest wall. Ptosis occurs when the breast mass descends, stretching the skin envelope. Clinically, ptosis is confirmed when the nipple drops to or below the IMF, leading to a loss of projection and upper pole fullness.
Primary Factors Contributing to Ptosis
The physiological causes of breast ptosis involve the gradual breakdown of internal and external supporting structures. The internal support system includes Cooper’s ligaments, fibrous bands of connective tissue connecting the breast to the chest wall. Over time, these ligaments stretch and weaken, allowing the breast tissue to descend under gravity.
Skin Elasticity and Lifestyle
The external support, the skin envelope, loses elasticity as collagen and elastin fibers diminish due to aging. Significant weight fluctuations repeatedly stretch the skin, reducing its ability to recoil. Hormonal changes from pregnancy and subsequent shrinking of milk glands after breastfeeding also contribute to skin laxity. Genetic predisposition, higher body mass index, larger cup size, and smoking can accelerate the loss of skin firmness.
Grading Systems for Severity
Healthcare providers classify the severity of breast ptosis using standardized systems, most commonly the Regnault classification. This system relies on the position of the nipple-areola complex (NAC) relative to the inframammary fold (IMF) to determine treatment.
Regnault Classification Grades
The classification defines the severity based on the NAC position:
- Grade I (Mild Ptosis): The nipple sits at the level of the IMF, though most breast tissue remains above it.
- Grade II (Moderate Ptosis): The nipple descends below the IMF but remains above the lowest contour of the breast mound.
- Grade III (Severe Ptosis): The nipple is positioned below the IMF and is the lowest point of the entire breast contour.
- Pseudoptosis: The breast tissue sags below the IMF, but the nipple remains positioned at or above the fold.
Surgical Correction Options
The primary surgical solution for correcting breast ptosis is mastopexy, commonly known as a breast lift. The goal is to reshape the breast by removing excess skin, tightening tissue, and repositioning the nipple-areola complex (NAC) to an elevated position. The underlying breast tissue is often reshaped and lifted to improve contour and firmness within the new skin envelope.
Incision Patterns for Mastopexy
The extent of the ptosis dictates the specific incision pattern used to achieve the necessary lift.
- Mild Ptosis: A periareolar incision around the areola may be sufficient (a “donut lift”).
- Moderate Ptosis: Requires a vertical pattern, involving incisions around the areola and extending vertically down to the inframammary fold (a “lollipop”).
- Severe Ptosis: Requires the anchor or inverted-T incision, which includes periareolar, vertical, and a third horizontal incision along the inframammary fold.
This pattern allows for maximum skin removal and tissue reshaping. If significant volume has been lost, an augmentation-mastopexy (including a breast implant) may be performed to restore fullness.